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| Plan Name | CENTER FOR INTERVENTIONAL PAIN & SPINE LIFE INSURANCE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | CENTER FOR INTERVENTIONAL PAIN & SPINE LLC |
| Employer identification number (EIN): | 274940541 |
| NAIC Classification: | 621111 |
| NAIC Description: | Offices of Physicians (except Mental Health Specialists) |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-05-01 | TYLER ROBERTS | 2023-09-07 | ||
| 501 | 2021-05-01 | ||||
| 501 | 2020-05-01 |
| Measure | Date | Value |
|---|---|---|
| 2022: CENTER FOR INTERVENTIONAL PAIN & SPINE LIFE INSURANCE PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-05-01 | 117 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-05-01 | 86 |
| Number of retired or separated participants receiving benefits | 2022-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-05-01 | 0 |
| Total of all active and inactive participants | 2022-05-01 | 86 |
| Number of employers contributing to the scheme | 2022-05-01 | 0 |
| 2021: CENTER FOR INTERVENTIONAL PAIN & SPINE LIFE INSURANCE PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-05-01 | 149 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-05-01 | 117 |
| Number of retired or separated participants receiving benefits | 2021-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-05-01 | 0 |
| Total of all active and inactive participants | 2021-05-01 | 117 |
| 2020: CENTER FOR INTERVENTIONAL PAIN & SPINE LIFE INSURANCE PLAN 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-05-01 | 129 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-05-01 | 143 |
| Number of retired or separated participants receiving benefits | 2020-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-05-01 | 0 |
| Total of all active and inactive participants | 2020-05-01 | 143 |
| 2022: CENTER FOR INTERVENTIONAL PAIN & SPINE LIFE INSURANCE PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-05-01 | Type of plan entity | Single employer plan |
| 2022-05-01 | Plan funding arrangement – Insurance | Yes |
| 2022-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: CENTER FOR INTERVENTIONAL PAIN & SPINE LIFE INSURANCE PLAN 2021 form 5500 responses | ||
| 2021-05-01 | Type of plan entity | Single employer plan |
| 2021-05-01 | Submission has been amended | No |
| 2021-05-01 | This submission is the final filing | No |
| 2021-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-05-01 | Plan is a collectively bargained plan | No |
| 2021-05-01 | Plan funding arrangement – Insurance | Yes |
| 2021-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: CENTER FOR INTERVENTIONAL PAIN & SPINE LIFE INSURANCE PLAN 2020 form 5500 responses | ||
| 2020-05-01 | Type of plan entity | Single employer plan |
| 2020-05-01 | First time form 5500 has been submitted | Yes |
| 2020-05-01 | Submission has been amended | No |
| 2020-05-01 | This submission is the final filing | No |
| 2020-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-05-01 | Plan is a collectively bargained plan | No |
| 2020-05-01 | Plan funding arrangement – Insurance | Yes |
| 2020-05-01 | Plan benefit arrangement – Insurance | Yes |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 161981 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | GL 161981 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | GL 161981 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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